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Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario



Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process.


The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children.


Adult parents of children aged 1–16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability.


After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11–45%, p < 0.01], and had higher total knowledge [mean difference (MD) 2.8, 95% CI 2.2–3.5, p < 0.01], conceptual knowledge (MD 0.7, 95% CI 0.4–1.1, p < 0.01) and numerical knowledge (MD 2.1, 95% CI 1.6–2.5, p < 0.01). Between-group differences in attitudes or intention to use antibiotics were not significant. Most intervention group participants found the information understandable and liked the aids’ format and features.


The decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated.

Clinical Trials Registration Number: ACTRN12615000843550.

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The authors thank Bridget Abell, Sharon Sanders, and Laura Bergade for assistance with recruitment and survey administration, and Elaine Beller for statistical advice.

Authors contributions

All authors contributed to the study design and data interpretation. Tammy Hoffman conceptualised the decision aids, and Peter Coxeter, Tammy Hoffman and Chris Del Mar developed the decision aids and designed the trial protocol. Peter Coxeter led the administration of the trial and statistical analysis, and wrote the first draft of the article. All authors contributed to subsequent drafts and the final version.

Author information

Correspondence to Tammy C. Hoffmann.

Ethics declarations

This study was approved by the Bond University Human Research Ethics Committee and was conducted in accordance with the ethical standards of the Declaration of Helsinki. Informed consent was obtained from all participants prior to study enrolment.

Conflict of interest

Peter Coxeter, Chris Del Mar and Tammy Hoffman declare no competing interests.


The National Health and Medical Research Council funded the study (APP1044904), and the Australian Commission on Safety and Quality in Healthcare funded the development of the decision aids, but played no role in the conduct of the study, analysis, or interpretation of results.

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Coxeter, P.D., Del Mar, C.B. & Hoffmann, T.C. Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario. Patient 10, 463–474 (2017). https://doi.org/10.1007/s40271-017-0223-2

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